Addressing the Opioid Epidemic in Primary Care Using A Collaborative Pharmacy Practice Model

INTRODUCTION: High-risk prescribing of opioids and benzodiazepines (BZDs) in primary care contributes significantly to poor patient outcomes and mortality. There is a critical need for effective, scalable strategies to support clinicians in deprescribing these medications safely. Pharmacist-led collaboration has shown benefit; however, the data is limited.

OBJECTIVE: The primary objective of this study was to evaluate the impact of a pharmacist-led, collaborative quality improvement program on opioid-related prescribing in primary care practice.

METHODS: This retrospective program evaluation was conducted from July 1, 2018 to June 30, 2020 in a large healthcare system with approximately 56 primary care offices and ~297,000 patients. The intervention consisted of four ambulatory care clinical pharmacists providing consultations to primary care providers for patients on chronic opioid therapy (>30 days). The efficacy outcomes include the change in the total number of opioid prescriptions, the number of patients prescribed ≥90 morphine milligram equivalents (MME) daily, and the number of patients co-prescribed opioids and BZDs.

RESULTS: Across all campuses, the number of patients receiving opioids ≥90 MME/day decreased by 21.16% (from 808 to 637; p=0.0072) between Q2 2019 and Q2 2020. At the two campuses with available data, concurrent opioid with BZD use decreased by 35.35% (from 959 to 620 patients; p< 0.0001). The overall number of opioid prescriptions decreased by 12.44% from Q3 2018 to Q2 2020, though this change was not statistically significant (p=0.0694).

CONCLUSION: A collaborative, pharmacist-led program was associated with significant reductions in high-risk prescribing, including high-dose (≥90 MME) opioid regimens and concurrent use of opioids and BZDs. Integrating pharmacists into primary care teams is a potential strategy to mitigate risk associated with controlled substance polypharmacy. Future research should aim to evaluate the long-term effectiveness of such interventions and measure patient-centered outcomes, including functional status and quality of life as well as morbidity and mortality.